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Montana rates for HCPCS Q5111

Injection, pegfilgrastim-cbqv (Udenyca), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,447.50 / $15,447.50 / $15,447.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $116.97 / $2,012.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.70 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.75 / $186.75 / $186.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $186.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $128.66 / $186.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.37 / $172.06 / $188.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33